RECONSTRUCTIVE UROLOGY

doi: 10.1590/S1677-55382010000400022

Internal urethrotomy and intraurethral submucosal injection of triamcinolone in short bulbar urethral strictures
Mazdak H, Izadpanahi MH, Ghalamkari A, Kabiri M, Khorrami MH, Nouri-Mahdavi K, Alizadeh F, Zargham M, Tadayyon F, Mohammadi A, Yazdani M
Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Int Urol Nephrol. 2009; 1. [Epub ahead of print]

• Objectives: In clinical practice, internal urethrotomy is an easy procedure and is offered as a first modality for treatment of short urethral strictures. Internal urethrotomy refers to any procedure that opens the stricture by incising or ablating it transurethrally. The most common complication of internal urethrotomy is stricture recurrence. The curative success rate of internal urethrotomy is approximately 20%. Triamcinolone has antifibroblast and anticollagen properties. This study evaluated the efficacy of triamcinolone in the prevention of anterior urethral stricture recurrence after internal urethrotomy.
  Methods: Fifty male patients with anterior urethral stricture were randomized to undergo internal urethrotomy with or without urethral submucosal injection of triamcinolone. Using general anesthesia urethrotomy was performed. Triamcinolone (40 mg) was injected submucosally at the urethrotomy site in 25 patients. The patients were followed for at least 12 months and the stricture recurrence rate was compared between the two groups.
  Results: 23 patients in the triamcinolone group and 22 in the control group completed the study. There were no significant differences in the baseline characteristics of the patients or the etiology of the stricture between the two groups. Mean follow-up time was 13.7 ± 5.5 months (range: 1-25 months). Urethral stricture recurred in five patients (21.7%) in the triamcinolone group and in 11 patients (50%) in the control group (P = 0.04).
  Conclusions: Injection of triamcinolone significantly reduced stricture recurrence after internal urethrotomy. Further investigations are warranted to confirm its efficacy and safety.

• Editorial Comment
  In this study men were randomized to steroid injection vs. no injection after internal urethrotomy for short (< 1.5 cm), treatment-naïve bulbar urethral strictures. Follow-up was with urethrography and urethroscopy every 6 months or when symptoms recurred. Treatment failure was defined as need for repeat treatment. Patients were similar in the two groups in all respects. Recurrence rate was 22% in the treatment group and 50% in the control group at mean follow-up of just over a year. These results are encouraging and we look forward to future reports with longer follow-up. Some shortcomings of this study deserve mention and point to areas for improvement in the design of future studies which attempt to answer this question. The study was not blinded and there was no placebo. Future studies should blind the surgeon and patient to injection with steroid vs. saline. The study outcome is fairly subjective. A more objective outcome would be a standardized assessment such as the ability to pass a cystoscope.

Dr. Sean P. Elliott
Department of Urology Surgery
University of Minnesota
Minneapolis, Minnesota, USA
E-mail: selliott@umn.edu